This application does not guarantee an On-Campus Housing Lease, but will allow you to be placed on our waiting list. Returning Sophomores will be given first priority.

There is no guarantee of roommate preference. You do have the option below to list a preference. Roommates will be assigned in early July.

Iowa Lakes Community College has the right to refuse housing.(Iowa Code 692A.2A states no sex offender may reside within 2000 feet of a child care facility or a public or nonpublic elementary or secondary school)

You may choose to submit this application electronically, or by mail, to the following address:
Jeremy Ward, Housing Coordinator
Iowa Lakes Community College
3200 College Drive
Emmetsburg, IA 50536

Please fill out the entire application and sign/submit at the bottom.

* Indicates a required field

Student Status:

*

Freshman

Sophomore

Emmetsburg Dormitory Preference:

Ballaster

Spinnaker

Catamaran

Iowa Lakes GPA:

Gender:

*

Male

Female

Last Name:

*

First Name:

*

Middle Initial:

Date of Birth:

*

Email Address (Do not use a high school email address):

*

Cell phone number:

*

Street Address:

*

City:

*

State:

*

Zip:

*

Parent/Guardian Name(s):

*

Parent/Guardian Street Address:

*

Parent/Guardian City:

*

Parent/Guardian State:

*

Parent/Guardian Zip:

*

Parent/Guardian Home Phone:

*

Parent/Guardian Work Phone:

Applying for semester beginning:

*

Fall

Spring

Summer

Year:

*

Academic Program:

*

Advisor's Name (if known):

Do you have any special needs to be considered?:

*

No, I do not have any special needs to be considered.

Yes, I do have special needs to be considered.

If yes for special needs, please describe:

If known, roommate preference by name:

Things about yourself for roommate compatibility:

*

Outgoing

Non-Smoker (All dorms are smoke & alcohol free)

Quiet Environment

Have Job

Very Neat

Early to Bed

Convicted Felon:

*

No

Yes

Sex Offender:

*

No

Yes

Name / Signature:

*

Date:

*

Email-12D1E03D380F12FC2B7A2887AD753D342BFB0812grip-e-hpEnter WordsIf you are not sure what the words are, enter your best guess.

By submitting this application, I certify that all information I have supplied on this application and my supporting documents is true.